Rates of Cesarean Conversion and Associated Predictors and Outcomes in Planned Vaginal Twin Deliveries

Jenny Y. Mei; Hector E. Muñoz; Jessica S. Kim; Alec Szlachta-McGinn; Cinthia Blat; Rashmi Rao; Christina S. Han; Roxanna A. Irani; Yalda Afshar

doi:10.1055/s-0040-1718368

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2022; 39(06): 601-608
DOI: 10.1055/s-0040-1718368

Original Article

Rates of Cesarean Conversion and Associated Predictors and Outcomes in Planned Vaginal Twin Deliveries

Authors

Jenny Y. Mei

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
Hector E. Muñoz

²Department of Bioengineering, University of California, Los Angeles, California
Jessica S. Kim

³Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
Alec Szlachta-McGinn

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
Cinthia Blat

³Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
Rashmi Rao

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
Christina S. Han

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California
Roxanna A. Irani

⁴Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
Yalda Afshar

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California

Abstract

Objective Twin vaginal deliveries (VDs) are often performed in the operating room (OR) given the risk of conversion to cesarean delivery (CD) for the aftercoming twin. We aim to investigate the rates of conversion to CD for planned twin VDs and identify predictors and outcomes of conversion.

Study Design A retrospective cohort study of all women who underwent a planned twin VD at two large academic medical centers over 4 years. Demographic and outcome data were chart abstracted. Various statistical tests were used to evaluate the influence of perinatal variables on mode of delivery and identify possible predictors of conversion.

Results Eight hundred and eighty-five twin deliveries were identified, of which 725 (81.9%) were possible candidates for VD. Of those, 237 (32.7%) underwent successful VD of twin A. Ninety-five (40.1%) had a nonvertex second twin at time of delivery. Conversion to CD occurred in 10 planned VDs (4.2%). Conversions were higher with spontaneous labor (relative risk [RR]: 2.1; 95% confidence interval [CI] 1.6–2.7; p = 0.003), and having an intertwin delivery interval greater than 60 minutes (RR: 5.1; 95% CI: 2.5–10.8; p < 0.001). Nonvertex presentation of twin B, type of delivery provider, or years out in practice of delivery provider were not significantly different between groups. There were no significant differences in neonatal outcomes between VD and conversion groups. There was a significant association between use of forceps for twin B and successful VD (p = 0.02), with 84.6% in the setting of a nonvertex twin B.

Conclusion Successful VD was achieved in planned VD of twins in 95.8% of cases, and there were no significant differences in maternal and fetal outcomes between successful VD and conversion to CD for twin B. With the optimal clinical scenario and shared decision-making, performing vaginal twin deliveries in labor and delivery rooms should be discussed.

Key Points

There is a propensity to perform twin vaginal deliveries in the operating room.
Rates of conversion to cesarean section are very low.
There are no significant differences in perinatal outcomes with conversion.

Keywords

twin vaginal deliveries - conversion to cesarean section - resource utilization - perinatal outcomes

Volltext

Referenzen

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